Provider Demographics
NPI:1386646297
Name:ZACHER, JEFFREY JEROME (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JEROME
Last Name:ZACHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3931 E CAMELBACK RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2609
Mailing Address - Country:US
Mailing Address - Phone:602-687-7858
Mailing Address - Fax:602-687-9276
Practice Address - Street 1:3931 E CAMELBACK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2609
Practice Address - Country:US
Practice Address - Phone:602-687-7858
Practice Address - Fax:602-687-9276
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30895207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ765878Medicaid
18278Medicare UPIN
AZ765878Medicaid